PART-A GIPEDI APPLICATION FORM CATEGORY: ______

From Table 3

BATCH: Year : Mode: o EARLY DECISION o Female?

____ (1/2/3/4)
o REGULAR DECISION
GENDER
Starting on: 15 JAN / MAY / JULY / DEC Ending on: 14 JAN / MAY / JULY / DEC (CHOOSE DATES)

Name:
FIRST NAME MIDDLE NAME SURNAME PHOTO WITH WHITE
Mailing BACKGROUND WEARING
Address: WHITE OR LIGHT COLORED
CLOTHING (please write your
name on the back of the
Tel #: (____) Mobile: photo)
_ _ / _ _ / _ _ _ _
email(s): D D M M Y Y Y Y
OFFICIAL EMAIL ADDRESS FIRST; ALTERNATIVE FREE EMAIL ADDRESSES ALSO MAY BE GIVEN AS SECOND EMAIL DATE OF BIRTH
CURRENT INSTITUTE: Discipline:
ACADEMIC PROFILE ( ONLY STATE MARKS OBTAINED; DO NOT ENCLOSE COPIES OR ORIGINALS OF ANY CERTIFICATE)
Class 10:
LANGUAGE1 SCIENCE MATHS SST LANGUAGE2 AGGREGATE RANK, IF ANY
Class 12:
PHYSICS CHEMISTRY BIO MATHS OTHER:……… LANGUAGE1 AGGREGATE RANK, IF ANY
BACHELORS
SEM-1 SEM-2 SEM-3 SEM-4 SEM-5 SEM-6 SEM-7 AGGREGATE RANK, IF ANY
MASTERS
SEM-1 SEM-2 SEM-3 SEM-4 RANK, IF ANY

MAJOR AREA ? COMPUTERS / COMMUNICATION / CONTROL / MICROELECTRONICS / POWER ELECTRONICS / POWER SYSTEMS
PROPOSED TOPIC OF MINOR AREA ?
INTERNSHIP (ONE
ONLY):

o I have attached my Statement of Purpose separately (Statement of Purpose : Please attach separately – see page 20 (maximum 1 page
typed in single-space 12 pt font).
o I have attached descriptions of my projects done so far (Attach separately (maximum 1 typed page) – see page 21 giving details of
team size, your specific contributions, the deliverables, significance of what you did and highlighting objectives met.)
CONCURRENCE OF FACULTY MENTOR IN IIT DELHI (OPTIONAL [see FAQ 2.10] / ONLY NEEDED IF YOU ALREADY HAVE A MENTOR'S
CONSENT - do not fill a name if you have not obtained a prior agreement in writing from the proposed Faculty Mentor):

FACULTY MENTOR IN IITD: Signature:

Office Tel: IITD email: Date:

(Before consenting to become Faculty Mentors, Faculty are advised to see “GUIDELINES FOR SELECTING STUDENTS” available at
http://sites.google.com/site/gipediinterns/guidelines-for-facilitators)
o I have read the GUIDELINES FOR SELECTING STUDENTS (Faculty Mentor must fill this box)
o I have filled and signed the Faculty Consent Form in Part-B and enclosed it (Faculty Mentor must fill this box)
LOCAL ADDRESS (REQUIRED ONLY FOR APPLICANTS WHO ARE NOT APPLYING UNDER ANY MoU SUCH INSTITUTIONAL CONSENT (FROM TPO) :
AS IASc,KVPY,etc) I forward this application, having read and
o I state that I have a local address to stay in Delhi / NCR and, if selected, will make my own agreeing to comply with all terms and
arrangements for stay and travel to IIT Delhi as per Internship timings without any pre-conditions conditions of the GIPEDI.

LOCAL
Address:
Signature
Tel #: (____) Mobile: NAME:
email(s): Seal:
OFFICIAL EMAIL ADDRESS FIRST; ALTERNATIVE EMAIL ADDRESSES ALSO MAY BE GIVEN AS SECOND EMAIL

DECLARATION BY THE APPLICANT

1 I hereby certify that by signing and submitting this application, I certify the above facts to be true.
2 I also agree that if I apply for any Batch other than a upcoming Batch (i.e. any batch for which the application is not being advertised), the application fees
shall be forfeited and my application shall not be processed further unless I have applied under the Early Decision Scheme.
3 Indemnity: I also take full responsibility for any accident / loss and agree to insure myself against any such accident / loss of life / disability to myself arising
directly or indirectly due to/ during the internship. I agree that FITT or IIT Delhi will NOT be held responsible or liable for compensation in any manner for
any such accident / loss of life / disability to my self.
PAYMENT DETAILS by DD o EXEMPT o ED-APP-FEEs
NAME: Rs.500 in favor of "FITT IIT DELHI"

DATE: DD # : Rs:
PLACE: Signature BANK:

Please send the completed application to: GIPEDI Program, FITT (Attn: Prof.Subrat Kar/Mr.K.K.Roy), IIT Delhi, Hauz Khas, New Delhi 110016 India
PART-A GIPEDI APPLICATION FORM CATEGORY: ______
From Table 3
STATEMENT OF PURPOSE: If you need to include rich-media or matter which cannot be enclosed as text such as video, images,
audio you are encouraged to give a web link below where the media can be found. Please use a URL shortening service such as
bitly.com or tinyurl.com.
I have more information which can be found at: http://

Please send the completed application to: GIPEDI Program, FITT (Attn: Prof.Subrat Kar/Mr.K.K.Roy), IIT Delhi, Hauz Khas, New Delhi 110016 India
PART-A GIPEDI APPLICATION FORM CATEGORY: ______
From Table 3

Statement of Project Abstracts / Work Experience (For each project, please give the title, team size, your role, scope of what you
did, significance of what you did, approximate man-days, any referee(s) and their contact email and phone)If you need to include
rich-media or matter which cannot be enclosed as text such as video, images, audio please feel free to give a web link below where
the media can be found. Please use a URL shortening service such as bitly.com or tinyurl.com.
I have more information which can be found at: http://

Please send the completed application to: GIPEDI Program, FITT (Attn: Prof.Subrat Kar/Mr.K.K.Roy), IIT Delhi, Hauz Khas, New Delhi 110016 India
PART-A GIPEDI APPLICATION FORM CATEGORY: ______
From Table 3

Tell us about yourself in the form of an essay about what you expect to achieve as an Intern (highlight anything special which
you think will allow you to contribute to the community here at IIT Delhi ). If you wish to inform us of any extenuating
circumstances in your life so far which merit special consideration, please describes these in a precise manner at the end of the
essay. If you need to include rich-media or matter which cannot be enclosed as text such as video, images, audio please feel free to
give a web link at the end where the media can be found. Please use a URL shortening service such as bitly.com or tinyurl.com.
I have more information which can be found at: http://

Please send the completed application to: GIPEDI Program, FITT (Attn: Prof.Subrat Kar/Mr.K.K.Roy), IIT Delhi, Hauz Khas, New Delhi 110016 India
PART-A GIPEDI APPLICATION FORM CATEGORY: ______
From Table 3

APPLICANT RECOMMENDATION FORM (please photocopy this blank form if you need more LoRs)
(please ensure that you print or photocopy both pages of this form on the two sides of the same sheet of paper, not on separate sheets)
The Respondent Referee is requested to provide responses in his/her own handwriting (no box should be left unfilled in this table as that will disqualify the recommendation ) :
Respondent Referee's Name (FITT/IITD OFFICE to insert) the Handling # here :

Title (Prof. / Dr. / Mr. / Ms.) Applicant Name:

Designation Year / Discipline:

Institution/Employer Desired Area of Work:

Email address (ONLY OFFICIAL Phone number: (Area code)

EMAIL ADDRESSES PLEASE)

Phone # (with STD code) (Area code) Do you know the applicant personally (as a No / Yes(specify how)
relative / friend etc) ?
Respondent Referee's Postal
Address:

For Respondent Use Only

Please evaluate the applicant by placing a check after each characteristic to be evaluated in the column that most nearly represents your opinion. Compare the
applicant with a representative group of students qualified for graduate study to whom you have known and who have had approximately the same amount of
experience and training as the applicant. If you lack knowledge to make a definite rating, give your estimate of applicant's ability and also check the column
"Inadequate Opportunity to Observe."
Inadequate
Out- On what specific basis do you
opportunity to Below average Average Good Superior
standing assign the particular rating given ?
observe
Analytical Ability

Research Ability

Ability to master academic work

Fundamental knowledge in field

Skill/originality of research work

Lab / hands-on skills

Research productivity (papers

published/ talks given etc)
Ability in oral expression

Ability to write

Motivation towards a career

Initiative

Emotional stability and maturity

Self-reliance and independence

Ability to work with others

Ability to work in multicultural

environment
Leadership potential

Integrity

Creative or innovative talent

Imagination / Original thought

Potential for success in chosen

area
Growth observed during period

OVERALL RATING

Please send the completed application to: GIPEDI Program, FITT (Attn: Prof.Subrat Kar/Mr.K.K.Roy), IIT Delhi, Hauz Khas, New Delhi 110016 India
PART-A GIPEDI APPLICATION FORM CATEGORY: ______
From Table 3
OVERALL RANKING 5 Best student this year 5 Best student in ……. Years 5 Top …….% of students this year 5 Unable to rank

Against which group are you rating the applicant ? For example, all under-graduate students I have taught in the past four years.

How long have you known the applicant ? ………… years and As 5 As Research Advisor 5 As Course Advisor
………… months 5 As teacher (one course) 5 As teacher (several courses)
5 As Departmental Head / Chair
5 Other ………………………………………………………….
What do you consider the applicant's most outstanding talents or characteristics?

What are the applicant's chief weaknesses, or areas for growth ?

Please answer the following:

NO NO NO YES YES YES
Un- Enthusiastically
Not Fairly
Not Applicable enthusiastical Strongly , without
recommended strongly
ly reservation
1) Would you accept this applicant to your internship program?

2) If recommended, would you offer financial assistance if available?

Overall recommendation is:

Please add (by means of attachment, if needed) any comments that will assist in our making a judgment as to whether the applicant should be accepted to the
Internship Program of IIT Delhi

Please type your name, understanding that it is legally equivalent to your signature (if this recommendation is sent by electronic means) and constitutes your
certification that your responses and assessments are accurate and fair to the best of your knowledge.

Full Address of respondent (in (Name) Signature of Respondent

capitals) (Line 1)
(Line 2)
(City) PIN
Date
State:
Place

PLEASE SIGN, SEAL SECURELY IN A ENVELOPE AND RETURN TO APPLICANT.

The contents of this letter are CONFIDENTIAL and must NOT be shown to the Applicant.
The letter must be filled in by the Referee in his / her own handwriting.
The recommendation is only acceptable in this format - a separate Letter on your Letterhead is not acceptable.
Thank you for your time.

Please send the completed application to: GIPEDI Program, FITT (Attn: Prof.Subrat Kar/Mr.K.K.Roy), IIT Delhi, Hauz Khas, New Delhi 110016 India
PART-A GIPEDI APPLICATION FORM CATEGORY: ______
From Table 3

APPLICANT RECOMMENDATION FORM

(please ensure that you print or photocopy both pages of this form on the two sides of the same sheet of paper, not on separate sheets)
Please answer the following questions (no box should be left unfilled in this table as that will disqualify the recommendation ) :
Respondent Referee's Name (FITT/IITD OFFICE to insert) the Handling # here :

Title (Prof. / Dr. / Mr. / Ms.) Applicant Name:

Designation Year / Discipline:
Institution/Employer Desired Area of Work:
Email address (ONLY Phone number: (Area code)
OFFICIAL EMAIL ADDRESSES
Phone # (with STD code) (Area code) Do you know the applicant personally (as a No / Yes(specify how)
relative / friend etc) ?
Respondent Referee's Postal
Address:

For Respondent Use Only

Please evaluate the applicant by placing a check after each characteristic to be evaluated in the column that most nearly represents your opinion. Compare the
applicant with a representative group of students qualified for graduate study to whom you have known and who have had approximately the same amount of
experience and training as the applicant. If you lack knowledge to make a definite rating, give your estimate of applicant's ability and also check the column
"Inadequate Opportunity to Observe."
Inadequate
Out- On what specific basis do you
opportunity to Below average Average Good Superior
standing assign the particular rating given ?
observe
Analytical Ability

Research Ability

Ability to master academic work

Fundamental knowledge in field

Skill/originality of research work

Lab / hands-on skills

Research productivity (papers

published/ talks given etc)
Ability in oral expression

Ability to write

Motivation towards a career

Initiative

Emotional stability and maturity

Self-reliance and independence

Ability to work with others

Ability to work in multicultural

environment
Leadership potential

Integrity

Creative or innovative talent

Imagination / Original thought

Potential for success in chosen

area
Growth observed during period

Please send the completed application to: GIPEDI Program, FITT (Attn: Prof.Subrat Kar/Mr.K.K.Roy), IIT Delhi, Hauz Khas, New Delhi 110016 India
PART-A GIPEDI APPLICATION FORM CATEGORY: ______
From Table 3

OVERALL RATING
OVERALL RANKING 5 Best student this year 5 Best student in ……. Years 5 Top …….% of students this year 5 Unable to rank

Against which group are you rating the applicant ? For example, all under-graduate students I have taught in the past four years.

How long have you known the applicant ? ………… years and As 5 As Research Advisor 5 As Course Advisor
………… months 5 As teacher (one course) 5 As teacher (several courses)
5 As Departmental Head / Chair

5 Other ………………………………………………………….

What do you consider the applicant's most outstanding talents or characteristics?

What are the applicant's chief weaknesses, or areas for growth ?

Please answer the following:

NO NO NO YES YES YES
Enthusiastically,
Un-
Not Applicable Not recommended Fairly strongly Strongly without
enthusiastically
reservation
1) Would you accept this applicant to your internship program?
2) If recommended, would you offer financial assistance if available?
Overall recommendation is:

Please add (by means of attachment, if needed) any comments that will assist in our making a judgment as to whether the applicant should be accepted to the
Internship Program of IIT Delhi

Please type your name, understanding that it is legally equivalent to your signature (if this recommendation is sent by electronic means) and constitutes your
certification that your responses and assessments are accurate and fair to the best of your knowledge.

Full Address of respondent (in (Name) Signature of Respondent

capitals) (Line 1)
(Line 2) Date
(City) PIN
Place
State:

PLEASE SIGN, SEAL SECURELY IN A ENVELOPE AND RETURN TO APPLICANT.

The contents of this letter are CONFIDENTIAL and must NOT be shown to the Applicant.
The letter must be filled in by the Referee in his / her own handwriting.
The recommendation is only acceptable in this format - a separate Letter on your Letterhead is not acceptable.
Thank you for your time.

Please send the completed application to: GIPEDI Program, FITT (Attn: Prof.Subrat Kar/Mr.K.K.Roy), IIT Delhi, Hauz Khas, New Delhi 110016 India